TDNet Discover

Background: Sepsis has one of the highest mortality rates of hospitalized patients, yet there is not a “gold standard” diagnostic medical decision making tool outside of the intensive care unit. SIRS criteria have been used for the past three decades, but more recently an international committee introduced the qSOFA scoring system. A majority of research compares and contrasts these two tools;however, it overall does not consider the potential benefits of a combined SIRS and qSOFA scoring system. Purpose: The focus of current research is debating the utility of SIRS versus qSOFA, and minimal research exists discussing the possibility of combining the two medical decision-making tools. This research sought to identify any potential benefits or downfalls of a combined SIRS and qSOFA scoring system regarding the diagnosis of sepsis for patients outside of the ICU. Methods: An evidence-based clinical review was performed utilizing three medical databases, Medline, PubMed, and CINAHL Complete. Once articles were sifted through specific inclusion and exclusion criteria and were considered to be good quality by utilizing a quality assessment tool provided by the NHLBI, researchers individually reviewed articles on SIRS and qSOFA, then came together to discuss the results. Results: Three research studies were focused on for this EBCR. All three studies were meta-analyses and systematic reviews. This included a combined total of 59 articles and 348,729 patients. Research indicated SIRS criteria had a higher sensitivity, whereas qSOFA scores had a higher specificity when diagnosing sepsis outside of the ICU. The opposite was also found to be true: SIRS was less specific than qSOFA, and qSOFA had a relatively low sensitivity for the diagnosis of sepsis, resulting in inconclusive results. Conclusion: Based on this research, the recommendation of a simple combination of SIRS and qSOFA should not be utilized for initial combined evaluation, rather SIRS should be used for the initial diagnosis of sepsis while qSOFA is better suited for disposition and management of patients after initial diagnosis.